Ambulance Safety, Standards and Survival - EMS Safety Foundation

35 Pages·2012·5.34 MB·English

August 27, 2012 -NYC
Paramedic David Restucciokilled
BBaanngg ffoorr bbuucckk:: AAmmbbuullaannccee
SSSSaaaaffffeeeettttyyyy,, SSSSttttaaaannnnddddaaaarrrrddddssss aaaannnndddd SSSSuuuurrrrvvvviiiivvvvaaaallll
--WWhhaatt ddoo yyoouu nneeeedd ttoo kknnooww!!””
Nadine Levick, MD MPH
Research Director, EMS Safety Foundation
CEO, Objective Safety, New York, USA
Chair, TRB, EMS Subcommittee, National Academies
Friday September 7, 2012 What are we going to cover
today?
NYC
(cid:131)Key principles of ambulance transport safety
Funeral of (cid:131)Standards and Guidelines
PPaarraammeeddiicc –NFPA 1917 perspective
David Restuccio –NASEMSO MRAVD
–MarynReport
(cid:131)How to make your ambulance transport
environment safer right now
Goals and Learning Objectives Emergency Medical Services Emergency Medical Service
(EMS)
(cid:131)Educate on the risks to patients, transport and An important and unique transport (cid:131)What are the transport safety issues that
emergency medical service providers and the public system pertain to this important public service and
from ambulance transport adverse events public safety industry?
(cid:131)Identify and explore factors related to ambulance
ccrraasshheess aanndd iiddeennttiiffyy ppootteennttiiaall mmeecchhaanniissmmss ooff iinnjjuurryy ttoo (cid:131)PPuubblliicc ssaaffeettyy, ppuubblliicc hheeaalltthh (cid:131)What do we know of the risks and hazards and
EMS transport providers, patients and the public and and emergency service how can we measure these ?
expose safety myths (cid:131)How can the safety of this transport system be
(cid:131)Instruct providers on strategies for enhancing (cid:131)Is there to save lives optimized?
transport safety and reducing risk of injury to patients (cid:131)What can we learn from and share with our
and providers and the public during transport
international colleagues
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Your electronic http://www.objectivesafety.net
Your electronic Handout handout/resource card Your Handout and Additional Resources
awaits you online at…
(cid:131) www.objectivesafety.net
Or if you are
< 3300 yyeeaarrss
TThhiiss WWIILLLL bbee FFAASSTT!!!!
No need to take any notes –all text
slides will be awaiting you in your
online Handout
How do you use an eTagfor the Your handouts etagpage Who am I?
first time?
Get Microsoft Tag App on your smartphone (cid:102)Nadine Levick MD, MPH
(free from your App store, it reads ALL eTags) 11 (cid:102)Emergency Medicine Physician and Public
open Tag App and scan the eTag Health Academic, (USA-Hopkins, Columbia
22 SUNY & Australia –Royal Melbourne, Royal
ChildrensHospitals, Royal Australian Flying
3333 Doctor Service)
(cid:102)Chair, National Academies Subcommittee TRB
EMS Transport Safety, USA
for those not of the Y or @ generation! (cid:102)Founder of EMS Safety Foundation
-if you have a smart phone (cid:102)Recipient, International Society of Automotive
-and you have downloaded free Tag Reader Engineers, Women’s Leadership Award for EMS
www.objectivesafety.net/PDFHO.htm -point your phone and capture this etagto get today’s Safety
form will open directly on your phone handout on your phone
White House Safety
Interdisciplinary Innovation Goals
Data Palooza
Consortium
September 14, 2012
(cid:131)Cheaper
(cid:131)(cid:131)BBeetttteerr
(cid:131)Safer
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EMS Transport Safety September 4, 2012-Las Vegas Things can go wrong –
but when there are sound safety policies and
technologies in place, and the system is well
(cid:131)‘patient safety’ prepared, you can minimize harm
AND also
(cid:131)‘provider’ and ‘public safety’
Fatal injuries among EMTs and Balance of concerns and
paramedics, 2003-2010* Science behind Policy
risk during transport
Other
11%
Assaults and Aircraft incidents (cid:131)“For successful technology, reality must
violent acts 8%
34% take precedence over public relations,
Other transportation 7% for Nature cannot be fooled.”
iinncciiddeennttss TToottaall = 9977
Struck by vehicle 7% Richard P. Feynman 1988 (cid:131) Response and transport time
32% (cid:131) Clinical care provision
Highway incidents (cid:131) Occupant safety/protection
* Data for 2010 are preliminary. Percents may not add to 100 due to rounding.
Source: Bureau of Labor Statistics, Census of Fatal Occupational Injuries (cid:131) Public Safety
the EMS transport process The Emergency Department (ED)
Safety of the…
(cid:131) communications/dispatch
(cid:131) the patient T
(cid:131) restraining device/seat I
(cid:131)Provider (cid:131) transporting device/gurney M
(cid:131)(cid:131)PPuubblliicc (cid:131)(cid:131) ppaartiaemnte mdiocsn/ittroarninsgp oerqtu nipumrseenst, doctors & family E
(cid:131)Patient (cid:131)(cid:131) cplrionticeaclt ivcea reeq &u iipnmteervnetntions &
(cid:131) the vehicle
(cid:131) the driver/driving skill PLACE
(cid:131) other road users
(cid:131) the road
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An ambulance is notan ED /ICU on
Firstly!
wheels
(cid:131)An accident ?
(cid:131)or
a predictable and preventable
event
A tragic emergency health care intervention Negative impact on system
A devastating tragedy…
outcome performance…
(cid:131)An ETT down the wrong hole (cid:131)BUT an EMS crash can kill all those
may kill your patient and be a involved AND wipe out a rural EMS
tteerrrriibbllee bbuurrddeenn ffoorr tthhee ppttss ffaammiillyy ssyysstteemm AANNDD nneeggaattiivveellyy iimmppaacctt aa
and for the medic involved regions response capacity……
It does happen….
Ambulance Transport Safety Ground Ambulance Transport Safety
IS Complex AND Multidisciplinary
So
(cid:131)Emergency care, public heath, public EDpaitdae Cmoiollleocgtiicoanl ManRagisekm ent SPaufbelitcy
safety, and patient transportation.
Ergonomic
(cid:131)Important Principle: Research Transport TrPaonlsicpyort (cid:131)What’s important
AAmmbbuullaannccee ttrraannssppoorrtt ssaaffeettyy iiss ppaarrtt ooff aa BBiioommeecchhaanniiccaall Safety
system, the overall balance of risk Automotive Safety PPE (cid:131)What’s not important
involves the safety of all occupants and BiohRaezsaeradr/Cchhem TDrariinveinrg
the public
(cid:131)All get home safely Comtemchunnoicloagtiyons TecShanfeotloy gy RegSutalantdioanrsd sand FlPeerot gSraafme ty
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(cid:131)What’s going to save your life (cid:131)What’s going to hurt you (cid:131)What is factual
(cid:131)What might take your life (cid:131)WWhhatt’’s goiing tto prottectt you (cid:131)(cid:131)WWhhaatt iiss ggaarrbbaaggee
Letter to Abe Lincoln –1864 1864 Ambulance Design Patent
re: safety of ambulance design and diagrams
Almost 150 years ago
(cid:131)What is new
(cid:131)What is not new
USA 1980’s Then…. USA 1980’s Then…. Equipment hard to reach
And
And 2012…
NOW!…
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Innovation Now… Real world answers to real world
questions -
(cid:131)What features will enhance safety of my new vehicle
purchase? (cid:131)What we need to consider, where is the
(cid:131)What color scheme do I want on my vehicle to make ‘bang for buck’ in ambulance transport
it ssaafeesst? safetyy
(cid:131)Do I need a helmet, and if so which one? (cid:131)Where is the low hanging fruit?
(cid:131)What policies offer the safest system?
(cid:131)How do I get my team to address safety issues?
(cid:131)What data should I collect when something goes
wrong, and how to analyze it?
Ambulance Safety Research: We should use the best safety
WE DO HAVE TECHNICAL No longer such a New Field practices demonstrated in engineering
DATA!!!
Dan Berry
Transport Canada, Ministry of Health
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1960non ‘70 ‘78 ‘86 ‘93 ‘95 ‘96‘982001‘02‘03‘04‘05‘06‘07‘08‘09‘11
issue ? safe safer
and in ergonomics Range of reach.. This is a well
ESV July 2009
defined technical science
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Who writes vehicle and
As well as epidemiological injury data
August, 2011 occupant safety standards??
http://www.ncbi.nlm.nih.gov/pubmed/21834620 (cid:131) FMVSS
(cid:131) SAE
(cid:131) CEN
(cid:131) ASA
(cid:131)(cid:131) IISSOO
(cid:131) KKK –only ambulances
(cid:131) AMD –only ambulances
(cid:131) ASTM –only ambulances
(cid:131) NFPA –for fire trucks and now ambulances
(cid:131) Health Care providers –MARYN report
The 2012 TRB EMS Safety Summit
2012 EMS Safety Systems, print th(cid:131)is pOapgee &n iynogu rA sdmdarrte pshso:n eA w.iJll. pHlaey itghhe t8m saesnsions from the eTags! (even in B&W)
Strategies and Solutions Summit (cid:131) Safety Developments Update –N. Levick
(cid:131) Research needs assessment forms explained –E. Frazer
(cid:131)One Day event, 30 presentations 1: Data and Recent Initiatives
(cid:131)Held in Washington DC, Keck Center 2: Transport, Human Factors -Bridging Diverse Disciplines
(cid:131)(cid:131)SSiimmuullccaasstt LLiivvee ttoo EEMMSS TTooddaayy 3: Testing and Standards
4: New systems safety technology solutions & telematics
(cid:131)Live Webinar Access -globally
5: Fleet management strategies
(cid:131)Over 100 participants live across 3 continents 6: Innovative Vehicle Design
(cid:131)Greater that 10,000 downloads of handouts 7: OperationalizingSafety
within the first week!! 8: Panel: How to optimize the safety of your existing fleet http://www.emssafetyfoundation.org/2012TRBSummitAgendawithLinks.pdf
Wrap up –from Prof. Art Cooper
The impaired/distracted Talking increases crash risk 5x The science of Stretcher
driver Texting is lifting & loading
(cid:131)Impairment COMPLETELY UNACCEPTABLE
–Illness
23X increase in crash risk
–Exhaustion
–Substance
–Emotion
–Distraction
•CELL PHONE !!!!! –(A MAJOR HAZARD)
•Other technology
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Size matters…. Less than 27 inches
Stretcher Load -# 1 (CNLOAD01) And what is the loading will save your back!!!!
height of your ambulance??
Course Design A lot is now possible and for
less!
(cid:131)One-day program
EMS SAFETY
(cid:131)Interactive lecture, discussion, group (cid:131)Driver behavior
CCOOUURRSSEE activities (cid:131)Vehicle behavior
(cid:131)Case studies using real incidents (cid:131)RRoaddsiidde IITTSS
National Association of (cid:131)8 hours continuing education credit (cid:131)Fuel consumption/Economics
Emergency Medical Technicians (CECBEMS) (cid:131)Resource modeling
(cid:131)Presented in 8 modules
Fleet Management technologies Spectrum of dimensions Telematics
(cid:131)ACETech/Ferno (cid:131)CAD
(cid:131)FleetEyes–Intermedix (cid:131)Resource allocation
(cid:131)Zollrescuenetand roadsafetyfleet (cid:131)Fleet performance –
managgement syystems –MMoonniittoorriinngg:: SSyysstteemm tthhaatt ggiivveess mmaannaaggeemmeenntt
(cid:131)Marvlis data of vehicle efficiency and use
(cid:131)Telematicus –Feedback: Directly to drivers at the wheel
(cid:131)Optima (cid:131)Public Alerts
(cid:131)Northrop Grumman
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Its out there NOW March 2012 EMSSF TRB Synopsis Webinar USA Ambulance Standards &
http://www.emssafetyfoundation.org/Recorded2012
March15ICTEPWebinarlogininfo.htm Testing
(cid:131)TRB 2012 Summit –addressed the key and
interdisciplinary applied solutions issues, in (cid:131) KKK A 1822F: Purchasing Guideline
one day –please seek that information out. –“Minimum Specification and performance parameters”
www.objectivesafety.net/TRBSummit2012.htm
(cid:131) AMD-001-025: Manufacturing Guideline
(cid:131)TThheerree hhaavvee bbeeeenn ttwwoo pprriioorr TTRRBB SSuummmmiittss hheelldd,,
2008, 2009 and both with vehicle engineering (cid:131) ASTM F2020-02a: Standard Practice
and transportation systems technical expertise
(cid:131)See www.trb.org, and for the Summit archives: (cid:131) NFPA 1917 Standard for Automotive Ambulances:
www.objectivesafety.net/TRBSummit2008.htm 2013 Edition
www.objectivesafety.net/TRBSummit2009.htm Click here www.youtube.com/watch?v=avFjl06bYcY
or scan this eTagto see it on You Tube
USA KKK ambulance purchase
Ambulance Standards and Testing International Ambulance Design
specifications
NFPA 1917 Safety and Occupant Protection
(cid:131)Interrelated –mostly Standard for Automotive Ambulances: GSA:KKK-A-1822F, Aug 2007
2013 Edition Standards
paraphrasing each to retire October 2013
other’s requirements (cid:131)Specifications for purchase of Star of Life Ambulance
In existence since 1999 (cid:131)Static Pull test
(cid:131)(cid:131)SSeellff cceerrttiiffiieedd (cid:131)Australia –ASA (cid:131)(cid:131)22220000 LLbbss. ssttaattiicc ssttrreettcchheerr tteesstt iinn
longitudinal, lateral & vertical
(cid:131)Europe -CEN
(cid:131)No dynamic test for vehicle,
occupants or equipment
(cid:131)No automotive test manikin
(cid:131)Voluntary
www.ntea.com/WorkArea/downloadasset.aspx?id=1352
USA Ambulance Manufacturing AMD ambulance ‘safety testing’ ? –Is NOT
Yes a “nationally recognized testing lab”
Division (AMD) consistent with accepted automotive safety –BUT -NOT an automotive/occupant
practice…
Ambulance Standards safety crash test lab!!
–August 2007
(being integrated into NFPA 1917)
(cid:131)No dynamic or impact test
(cid:131)No automotive test manikin
(cid:131)Mandates NO ‘crumple zone’
(cid:131)No impact tested anchorages for occupant restraint
or equipment
(cid:131)Internal, not independent & not a standardizing body
http://www.ntea.com/WorkArea/showcontent.aspx?id=1350
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The Laws of Physics Prevail.. No ‘a’… then NO ‘F’ !!!!! AMD 2007 -025 ‘static
occupant safety testing’
-Compared with -
(cid:131) F = ma
Accepted automotive
safety dynamic occupant
testing
where F –force
m –mass
a –acceleration
PhilosophiæNaturalisPrincipia
Mathematica, July 1687
NFPA 1917, August 2012
NFPA 1917 -Test Methods NFPA 1917 Testing Criteria
(based on KKK, AMD)
(cid:131)AMD Standards incorporated
(cid:131)Side load testing types I and III
(cid:131)(cid:131)AAllll aaddjjuussttaabbllee sseeaattss mmuusstt bbee
dynamically tested to SAE J2917
(cid:131)Seat belts for side facing seats tested to
FMVSS 210
SAE Ambulance Equipment NFPA -Key issues identified by
mounting testing standards EMS Safety Foundation
Frontal Impact SAE 2917, published May 2010
Side Impact SAE 2956, published June 2011 (cid:131)Key that meaningful safety data drive the
process
(cid:131)Need for ambulance safety, injury and
fatality mechanism outcomes data be used
(cid:131)Integration and collaboration with technical
automotive occupant protection and
crashworthiness expertise is paramount
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